Reverse Total Shoulder Arthroplasty — (rTSA)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

Sling in neutral rotation with abduction pillow (30-45 deg) wks 0-3; wean sling Phase II (4-6 wks); discontinue sling Phase III (7-8 wks)

Key Restrictions

No shoulder AROM or AAROM Phase I; no PROM into IR Phase I; no reaching behind back (especially IR) x 12 wks; no lifting >coffee cup through Phase III; no supporting body weight with hands; avoid shoulder hyperextension; pillow under elbow in supine to avoid hyperextension; PROM IR initiated gradually in scapular plane at 7-8 wks (≤50 deg); no push to end ranges

Timeline & Phases

5 phases: Phase I (immediate post-op, up to 3 wks, PROM, protect repair), Phase II (4-6 wks, gradual PROM/AAROM/AROM, scapular activation), Phase III (7-8 wks, progress PROM incl. IR in scapular plane; ROM goals elevation <=140, ER <=30 in neutral, IR <=50), Phase IV (9-11 wks, transitional, periscapular and deltoid strengthening), Phase V (12-16 wks, advanced strengthening, QuickDASH, MD clearance); revised December 2018

Notes

Criterion-based; deltoid and periscapular muscle emphasis throughout; scapular plane elevation primary motion; ER PROM to tolerance Phase I (≤120 deg flex, ≤90 deg ABD); posterior deltoid activation: avoid shoulder extension when isolating; specific complications to monitor: fever, numbness/tingling, excessive drainage, tenderness over acromion.

Surgeon / Author

MGH Sports Medicine